Signs characterizing acute vascular insufficiency syndrome. What is acute vascular insufficiency? Types of acute vascular insufficiency

Acute vascular insufficiency (ACF) is a pathological condition characterized by a sudden decrease in circulating blood volume and a sharp disruption of blood vessel function. Most often it is caused by heart failure and is rarely observed in its pure form.

Classification

Depending on the severity of the condition and the consequences for the human body, the following types of syndrome are distinguished:

• fainting;
• collapse;
• shock.

Important! All types of pathology pose a threat to human health and life; if emergency care is not provided in a timely manner, the patient develops acute heart failure and death.

Pathogenesis and causes

The entire human body is penetrated by large and small blood vessels through which blood circulates and supplies oxygen to organs and tissues. Normal distribution of blood through the arteries occurs due to the contraction of the smooth muscles of their walls and changes in tone.

Maintaining the desired tone of arteries and veins is regulated by hormones, metabolic processes of the body and the work of the autonomic nervous system. When these processes are disrupted and hormonal imbalance occurs, there is a sharp outflow of blood from vital internal organs, as a result of which they stop working as expected.

The etiology of AHF can be very diverse; a sudden disruption of blood circulation in the vessels occurs as a result of the following conditions:

• massive blood loss;
• extensive burns;
• heart disease;
• long stay in a stuffy room;
• traumatic brain injury;
• severe fear or stress;
• acute poisoning;
• adrenal insufficiency;
• Iron-deficiency anemia;
• excessive loads with severe hypotension, as a result of which internal organs experience oxygen deficiency.

Depending on the duration of the course, vascular insufficiency can be acute or chronic.

Clinical manifestations

The clinical picture of AHF is always accompanied by a decrease in blood pressure and directly depends on the severity of the condition; this is presented in more detail in the table.

Table 1. Clinical forms of pathology

Name	How does it manifest clinically?
Fainting	The patient suddenly feels weak, dizzy, and has “floaters” flashing before his eyes. Consciousness may be preserved or absent. If after 5 minutes the patient does not come to his senses, then fainting is accompanied by convulsions; as a rule, this rarely happens and with properly organized help the person’s condition quickly normalizes
Collapse	This condition is much more severe than fainting. The patient's consciousness can be preserved, but there is severe inhibition and disorientation in space. Blood pressure is sharply reduced, the pulse is weak and thready, breathing is shallow and rapid. The skin is pale, acrocyanosis and sticky cold sweat are observed.
Shock	Clinically, shock is not much different from collapse, but in this condition a sharp depression of the heart and other vital organs develops. Due to severe hypoxia, the brain suffers, against the background of which degenerative changes can develop in its structure

Fainting, collapse, shock: more about each condition

Fainting

Fainting is a form of AHF, which is characterized by the mildest course.

The causes of fainting are:

1. sudden decrease in blood pressure - occurs against the background of diseases and pathologies that are accompanied by cardiac arrhythmias. At the slightest physical overload, blood flow in the muscles increases as a result of blood redistribution. Against this background, the heart cannot cope with the increased load, blood ejection during systole decreases, and systolic and diastolic pressure levels decrease.
2. Dehydration – as a result of repeated vomiting, diarrhea, excessive urination or sweating, the volume of circulating blood through the vessels is reduced, which can cause fainting.
3. Nerve impulses from the nervous system - as a result of strong feelings, fear, excitement or psycho-emotional arousal, sharp vasomotor reactions and vascular spasm occur.
4. Impaired blood supply to the brain - against the background of a head injury, a minor stroke or stroke, an insufficient amount of blood and oxygen reaches the brain, which can lead to the development of fainting.
5. Hypocapnia is a condition characterized by a decrease in carbon dioxide in the blood due to frequent and deep breathing, which can lead to fainting.

Collapse

Collapse is a serious impairment of vascular function. The condition develops abruptly, the patient suddenly feels weak, the legs give way, tremors of the limbs, cold sticky sweat, and a drop in blood pressure appear.

Consciousness may be preserved or impaired. There are several types of collapse.

Table 2. Types of collapse

Important! Only a doctor can determine the type of collapse and correctly assess the severity of the patient’s condition, so do not neglect to call an ambulance and do not self-medicate; sometimes wrong actions are the price of a person’s life.

Shock

Shock is the most severe form of acute heart failure. During shock, severe circulatory disorders develop, which may result in the death of the patient. Shock has several phases of flow.

Table 3. Shock phases

Shock phase	How does it manifest clinically?
Erectile	Accompanied by sharp psychomotor agitation, the patient screams, waves his arms, tries to get up and run somewhere. Blood pressure readings are elevated, pulse is rapid
Torpidnaya	Quickly changes the erectile phase, sometimes even before the ambulance has time to arrive. The patient becomes lethargic, lethargic, and does not react to what is happening around him. Blood pressure levels rapidly decrease, the pulse becomes weak, thread-like or cannot be felt at all. Pale skin with severe acrocyanosis, shallow breathing, shortness of breath
Terminal	Occurs in the absence of adequate timely assistance to the patient. Blood pressure is below critical, the pulse cannot be felt, breathing is rare or absent, the patient is unconscious, there are no reflexes. In such a situation, death quickly develops.

Depending on the causes of shock syndrome, AHF occurs:

• hemorrhagic – develops against the background of massive blood loss;
• traumatic – develops as a result of severe trauma (road accidents, fractures, soft tissue damage);
• burn – develops as a result of severe burns and damage to a large area of ​​the body;
• anaphylactic - an acute allergic reaction that develops due to the administration of a drug, insect bites, vaccination;
• blood transfusion - occurs against the background of transfusion of red blood cells or blood incompatible with the blood group to the patient.

The video in this article describes in detail all types of shock and the principles of emergency first aid. This instruction, of course, is for general informational purposes only and cannot replace the help of a doctor.

Treatment

First medical aid for AHF directly depends on the type of pathology.

Fainting

As a rule, treatment of fainting occurs without the use of medications.

Emergency care for fainting type of fainting consists of the following actions:

• place the patient in a horizontal position with the leg end raised;
• unbutton the buttons of your shirt and free yourself from clothing that is constricting your chest;
• provide access to fresh cool air;
• Spray your face with water or wipe your forehead and cheeks with a wet cloth;
• give warm sweet tea or weak coffee to drink if the patient is conscious;
• in the absence of consciousness, pat your cheeks and apply cold to your temples.

If the above actions are ineffective, you can inject vasoconstrictor drugs, for example, Cordiamin.

Collapse

First aid for collapse is aimed at eliminating the causes that provoked the development of this condition. First aid for collapse consists of immediately placing the patient in a horizontal position, raising the leg end and warming the patient.

If the person is conscious, then you can give him hot sweet tea. Before transport to the hospital, the patient is given an injection of a vasoconstrictor drug.

In a hospital setting, the patient is administered medications that eliminate both the symptoms of vascular insufficiency and the causes of this pathological condition:

• drugs that stimulate the respiratory and cardiovascular centers - these drugs increase the tone of the arteries and increase the stroke volume of the heart;
• vasoconstrictors - adrenaline, Dopamine, Norepinephrine and other drugs that quickly increase blood pressure and stimulate the heart are administered intravenously;
• infusion of blood and red blood cells - required in case of blood loss to prevent shock;
• carrying out detoxification therapy - droppers and solutions are prescribed that quickly remove toxic substances from the blood and replenish the volume of circulating fluid;
• Oxygen therapy – prescribed to improve metabolic processes in the body and saturate the blood with oxygen.

Possible nursing problems with AHF of the collapse type are the difficulty of giving the patient something to drink if his consciousness is impaired, and of administering the drug intravenously at low pressure - it is not always possible to immediately find a vein and get into the vessel.

Important! Saline solutions are not effective if the collapse is caused by the deposition of blood into the intercellular space and internal organs. In such a situation, to improve the patient’s condition, it is necessary to inject colloidal solutions into the plasma.

Shock

Treatment of shock consists of taking measures aimed at improving the systemic functions of the body and eliminating the causes of this condition.

The patient is prescribed:

• painkillers - in case of injuries and burns, before carrying out any actions, it is necessary to administer painkillers to the patient, which will help prevent the development of shock or stop it in the erectile stage;
• oxygen therapy – the patient is given humidified oxygen through a mask to saturate the blood with oxygen and normalize the functioning of vital organs; if consciousness is depressed, the patient is given artificial ventilation;
• normalization of hemodynamics - medications are administered that improve blood circulation, for example, red blood cells, colloidal solutions, saline solutions, glucose and others;
• administration of hormonal drugs - these drugs help to quickly restore blood pressure, improve hemodynamics, and relieve acute allergic reactions;
• diuretics - prescribed for the prevention and elimination of edema.

Important! With the development of AHF, all medications should be administered intravenously, since due to impaired microcirculation of tissues and internal organs, the absorption of medications into the systemic bloodstream changes.

Prevention measures

In order to prevent the development of acute vascular insufficiency, it is important to follow the doctor’s recommendations:

• promptly identify and treat diseases of the cardiovascular system;
• do not take any medications without a doctor’s prescription, especially for the treatment of arterial hypertension;
• do not stay in direct sunlight for a long time, in a bathhouse, sauna, especially if there are any disturbances in the functioning of the heart and blood vessels;
• Before blood transfusion, be sure to take tests to make sure that the donor’s blood matches the blood group and Rh factor.

Maintaining an active lifestyle, giving up bad habits, and a nutritious and balanced diet will help prevent disorders of the cardiovascular system and blood pressure.

Vascular insufficiency is a violation of local or general blood circulation, which is based on insufficiency of the function of blood vessels, caused in turn by a violation of their patency, a decrease in tone, and the volume of blood passing through them.

Deficiency can be systemic or regional (local) - depending on how the disorders spread. Depending on the rate of progression of the disease, there may be acute or chronic vascular insufficiency.

Pure vascular insufficiency is rare; most often, heart muscle insufficiency occurs simultaneously with symptoms of vascular insufficiency. Cardiovascular failure develops due to the fact that the same factors often affect the heart muscle and vascular muscles. Sometimes cardiovascular failure is secondary and heart pathology occurs due to poor muscle nutrition (lack of blood, low pressure in the arteries).

Reasons for appearance

The cause of the disease is usually circulatory disorders in the veins and arteries that arise for various reasons.

Basically, acute vascular insufficiency develops due to traumatic brain and general injuries, various heart diseases, blood loss, in pathological conditions, for example, acute poisoning, severe infections, extensive burns, organic lesions of the nervous system, adrenal insufficiency.

Symptoms of vascular insufficiency

Acute vascular insufficiency manifests itself in the form of fainting, shock or collapse.

Fainting is the mildest form of failure. Symptoms of vascular insufficiency during fainting: weakness, nausea, darkening of the eyes, rapid loss of consciousness. The pulse is weak and rare, the pressure is low, the skin is pale, the muscles are relaxed, there are no cramps.

During collapse and shock, the patient is in most cases conscious, but his reactions are inhibited. There are complaints of weakness, low temperature and blood pressure (80/40 mm Hg or less), tachycardia.

The main symptom of vascular insufficiency is a sharp and rapid decrease in blood pressure, which provokes the development of all other symptoms.

Chronic insufficiency of vascular function most often manifests itself in the form of arterial hypotension. Conventionally, this diagnosis can be made with the following symptoms: in older children - systolic pressure below 85, up to 30l. – pressure below 105/65, in older people – below 100/60.

Diagnosis of the disease

At the examination stage, the doctor, assessing the symptoms of vascular insufficiency, recognizes what form of insufficiency has manifested itself: fainting, shock or collapse. In this case, the level of pressure is not decisive in making a diagnosis; you should study the medical history and find out the causes of the attack. It is very important at the examination stage to establish what type of failure has developed: cardiac or vascular, because Emergency care for these diseases is provided in different ways.

If cardiovascular failure manifests itself, the patient is forced to sit - in a supine position his condition worsens significantly. If vascular insufficiency has developed, the patient needs to lie down, because in this position, his brain is better supplied with blood. The skin with cardiac failure is pinkish, with vascular failure it is pale, sometimes with a grayish tint. Vascular insufficiency is also distinguished by the fact that venous pressure is not increased, the veins in the neck are collapsed, the boundaries of the heart do not shift, and there is no congestion in the lungs characteristic of cardiac pathology.

After a preliminary diagnosis has been made based on the general clinical picture, the patient is given first aid, hospitalized if necessary, and an examination of the circulatory organs is prescribed. To do this, he may be prescribed to undergo vascular auscultation, electrocardiography, sphygmography, venography.

Treatment of vascular insufficiency

Medical care for vascular insufficiency should be provided immediately.

In all forms of acute vascular insufficiency, the patient should be left in a supine position (otherwise there may be death).

If fainting occurs, it is necessary to loosen the clothes around the victim’s neck, pat him on the cheeks, spray his chest and face with water, let him smell ammonia, and ventilate the room. This manipulation can be carried out independently; usually the positive effect occurs quickly, the patient regains consciousness. Afterwards, you should definitely call a doctor, who, after conducting simple diagnostic tests on the spot, will administer a solution of caffeine with sodium benzoate 10% - 2 ml subcutaneously or intravenously (with a recorded low blood pressure). If severe bradycardia is noticed, atropine 0.1% 0.5-1 ml is additionally administered. If bradycardia and low blood pressure persist, orciprenaline sulfate 0.05% - 0.5-1 ml or adrenaline solution 0.1% is administered intravenously. If after 2-3 minutes the patient still remains unconscious, pulse, pressure, heart sounds are not detected, there are no reflexes, these drugs are started to be administered intracardiacly, and artificial respiration and cardiac massage are performed.

If after fainting additional resuscitation measures are needed, or the cause of fainting remains unclear, or this happened for the first time, or the patient’s blood pressure remains low after regaining consciousness, he must be hospitalized for further examination and treatment. In all other cases, hospitalization is not indicated.

Patients with collapse who are in a state of shock, regardless of the cause that caused this condition, are urgently taken to the hospital, where the patient is provided with first emergency care to maintain blood pressure and heart function. If necessary, stop the bleeding (if necessary), carry out other symptomatic therapy procedures, focusing on the circumstances that caused the attack.

In case of cardiogenic collapse (often develops with cardiovascular failure), tachycardia is eliminated, atrial flutter is stopped: atropine or isadrine, adrenaline or heparin are used. To restore and maintain pressure, mesaton 1% is administered subcutaneously.

If collapse is caused by infection or poisoning, caffeine, cocarboxylase, glucose, sodium chloride, and ascorbic acid are injected subcutaneously. Strychnine 0.1% is very effective for this type of collapse. If such therapy does not bring results, mezaton is injected under the skin, prednisolongemisuccinate is injected into a vein, and sodium chloride 10% is injected again.

Disease prevention

The best prevention of vascular insufficiency is the prevention of diseases that can cause it. It is recommended to monitor the condition of blood vessels, consume less cholesterol, and undergo regular examinations of the circulatory system and heart. In some cases, hypotensive patients are prescribed a prophylactic course of blood pressure-maintaining medications.

Video from YouTube on the topic of the article:

Cardiovascular failure is a condition characterized by the inability of the cardiovascular system to provide adequate perfusion of organs and tissues. There are acute cardiovascular failure and chronic heart failure (CHF). Acute blood insufficiency

circulation includes the following forms: acute vascular failure (fainting, collapse, shock), acute right ventricular failure and acute left ventricular failure (cardiac asthma, pulmonary edema, cardiogenic shock). Fainting(apopsychia) is characterized by a short-term loss of consciousness due to insufficient blood circulation to the brain. When fainting, generalized muscle weakness occurs, arterial and venous pressure decreases, tension, filling and pulse decrease, and heart rhythm and respiratory activity are often disturbed. Fainting is quite common; about 30% of the adult population has had at least one fainting spell. It can be short-term, transient (lipathimia), or longer, deeper (syncope). Conditions with loss of consciousness are often called syncope. The most common pathogenetic variant of fainting is vasodepressor, which develops with strong psycho-emotional

voltage. During the precursor period, weakness, nausea, yawning, ringing in the ears, darkening of the eyes, dizziness, pallor, sweating, moderate hypotension, and bradycardia are detected. After emerging from an unconscious state, pallor, sweating, and a feeling of nausea may persist for some time. Collapse– a form of acute vascular insufficiency without obvious metabolic disorders, when the clinical picture is dominated by hypotensive syndrome. With timely and adequate therapy, the prognosis is often favorable. The causes of collapse can be divided into two groups: those associated with a primary decrease in circulating blood volume (CBV) and with a primary decrease in vascular tone.

The most common postural orthostatic hypotension is caused by a sharp decrease in blood pressure when standing up. It is observed in patients who have been on bed rest for a long time, with severe varicose veins of the lower extremities, in the last trimester of pregnancy,

with an abrupt cessation of significant physical activity, it can be iatrogenic when treated with ganglion blockers, beta blockers, diuretics and other antihypertensive drugs. Shock– this is a severe, life-threatening condition of the body with profound impairment of all systems, primarily the cardiovascular system, due to the body’s reaction to physical or mental damage. Total vascular insufficiency occurs with dysfunction of internal organs, changes at the level of microcirculation and metabolic disorders (acidosis, hormonal changes, hypercoagulation) increase. In acute vascular insufficiency, return decreases

blood to the heart, which inevitably leads to a decrease in cardiac output, which in turn aggravates the disturbances in the blood supply to organs. Of practical interest is the classification of pathogenetic variants of shock by C. Saunders (1992):

1 – hypovolemic (loss of bcc due to blood loss, loss of plasma due to burns, profuse vomiting, diarrhea);

2 – cardiogenic (myocardial infarction, severe arrhythmias);

3 – obstructive (massive pulmonary embolism);

4 – redistribution shock (sepsis, anaphylactic shock).

Almost always, as a result of insufficient perfusion in the brain, the psyche of patients suffers to one degree or another. Consciousness is often impaired, sometimes absent. If it is preserved, patients may be inhibited and have difficulty making contact. In some cases, anxiety may appear. Acrocyanosis develops, tissue turgor is sharply reduced, the limbs feel

cold, the skin is covered with sticky sweat, the pulse becomes thready. Auscultation reveals weakened sounds and tachycardia. The tongue is dry, the liver may be enlarged, and diuresis decreases. Based on the severity of clinical manifestations, blood pressure and hourly diuresis, three degrees of shock severity are distinguished. Acute right ventricular failure in the classical

This variant occurs with pulmonary embolism (PE). Of all the symptoms of pulmonary embolism, signs of right ventricular failure proper are pronounced cyanosis, swelling of the neck veins, enlarged veins, radiographic bulging of the conus pulmonary, on the ECG - deviation of the electrical axis to the right, overload of the right parts of the heart. From a morphological point of view, cardiac asthma corresponds to interstitial pulmonary edema; it often develops acutely and is manifested by increasing shortness of breath, suffocation, and dry cough. It often occurs at night. From the very beginning, the patient tries to assume a sitting position. On auscultation, hard breathing is heard, sometimes small amounts of dry wheezing. As interstitial pulmonary edema progresses, it can become alveolar, i.e. into true cardiogenic pulmonary edema. Pulmonary edema(cardiogenic) - often develops very quickly, within a few minutes, and only emergency measures sometimes allow the patient to be brought out of a serious condition. Severe shortness of breath occurs, a cough appears, initially dry and hacking. Excitement sets in, fear of death appears. Consciousness may become confused, acrocyanosis appears, turning into diffuse cyanosis. A dry cough quickly gives way to a wet cough with the release of bloody and then foamy sputum. IN

Vascular insufficiency is a disease characterized by a violation of general or local blood circulation, resulting from insufficient function of blood vessels, which, in turn, can be caused either by a decrease in their tone, impaired patency, or a significant decrease in the volume of blood passing through the vessels.

Deficiency is divided into systemic and regional (local), which differ in how the disorders spread. In addition, there are acute and chronic vascular insufficiency (the difference in the speed of the disease).

Typically, pure vascular failure is very rare and occurs simultaneously with cardiac muscle failure. The development of cardiovascular failure is facilitated by the fact that both the vascular muscles and the heart muscle are often influenced by the same factors.

Sometimes heart pathology becomes primary and appears due to insufficient muscle nutrition, and cardiovascular failure (including acute cardiovascular failure) is secondary.

Reasons for appearance

Typically, the cause of acute vascular insufficiency is a violation of blood circulation in the arteries and veins, which appears for various reasons (previous craniocerebral and general injuries, various heart diseases). Acute vascular insufficiency also occurs due to impaired contractile function of the myocardium, blood loss or a drop in vascular tone due to acute poisoning, severe infections, extensive burns, organic lesions of the nervous system, and adrenal insufficiency.

Symptoms of vascular insufficiency

Acute vascular insufficiency may manifest as shock, syncope, or collapse. Fainting is one of the mildest forms of failure. Symptoms of fainting include: weakness, darkening of the eyes, nausea, rapid loss of consciousness. The pulse is rare and weak, the skin is pale, the blood pressure is low, the muscles are relaxed, and no cramps are observed.

During shock and collapse, the patient, as a rule, does not lose consciousness, but his reactions are greatly inhibited. The patient complains of weakness, tachycardia, low blood pressure (80/40 mm Hg or less), and temperature below normal.

The main symptom of vascular insufficiency is a rapid and sharp decrease in blood pressure.

With chronic vascular insufficiency, arterial hypotension develops, determined by low blood pressure. Thus, systolic pressure in older children drops below 85, in people under 30 years of age the pressure is below 105/65, for older people this figure is below 100/60.

Diagnosis of vascular insufficiency

During the examination of the patient, the doctor evaluates the symptoms of vascular insufficiency and determines its form: fainting, shock or collapse. In making a diagnosis, the level of pressure is not decisive. In order for the conclusion to be correct, the doctor analyzes and studies the medical history and tries to find out the causes of the attack.

To provide qualified first aid, it is necessary to determine what type of failure the patient has developed: cardiac or vascular. The fact is that for these diseases emergency care is provided in different ways.

In case of heart failure, it is easier for the patient to be in a sitting position; in the lying position, the condition worsens significantly. In case of vascular insufficiency, the optimal position for the patient will be lying down, since it is in this position that the brain receives the best blood supply.

In case of heart failure, the patient’s skin has a pinkish tint; in case of vascular failure, the skin is pale, in some cases with a grayish tint. Vascular insufficiency is also characterized by the fact that venous pressure remains within normal limits, the veins in the neck are collapsed, the boundaries of the heart are not displaced, and the pathology of congestion in the lungs is not observed, as is the case with heart failure.

After clarifying the general clinical picture and determining a preliminary diagnosis, the patient is given first aid, if necessary, hospitalized and an examination of the circulatory organs is carried out. To do this, the patient is referred for auscultation of blood vessels, sphygmography, electrocardiography or venography.

Treatment of vascular insufficiency

In case of vascular insufficiency, medical assistance should be provided immediately. Regardless of the form of development of the disease, the patient is left in a lying position (another body position can cause death).

If the victim is in a faint state, loosen the clothes around his neck, pat his cheeks, spray his face and chest with water, let him smell ammonia, and ventilate the room.

Such manipulations can be carried out independently before the doctor arrives. As a rule, a person quickly regains consciousness. The doctor conducts simple diagnostic tests, injects intravenously or subcutaneously two milliliters of a solution of caffeine with sodium benzoate 10% (in case of recorded low blood pressure).

In case of severe bradycardia, an additional injection of atropine 0.1% in a dose of 0.5-1 milliliter or a solution of adrenaline 0.1% is given. After 2-3 minutes the patient should regain consciousness. If this does not happen, pressure, heart sounds and pulse are not determined, the same drugs begin to be administered intracardially, in addition, cardiac massage and artificial respiration are performed.

The patient is hospitalized if fainting occurs for the first time or its cause remains unclear or additional resuscitation measures are required, the pressure remains much lower than normal. In all other cases, there is no need for hospitalization.

Patients with collapse or shock are urgently taken to the hospital, regardless of the reasons that caused this condition. In a medical institution, first aid is provided, maintaining blood pressure and heart activity. If bleeding occurs, stop it and carry out other symptomatic therapy procedures indicated in a particular situation.

In case of cardiogenic collapse, which often develops in acute cardiovascular failure, it is necessary to eliminate tachycardia and stop atrial flutter, for which isadrine or atropine, heparin or adrenaline are used. To restore and maintain pressure, mesaton 1% is injected subcutaneously.

If the cause of collapse is infection or poisoning, cocarboxylase, caffeine, sodium chloride, glucose, and ascorbic acid are administered subcutaneously. Strychnine 0.1% gives a good effect. In the case when the patient remains in the same condition and no improvement is observed, mezaton is administered subcutaneously, prednisolongemisuccinate is administered intravenously, and the administration of sodium chloride 10% is repeated again.

Disease prevention

To prevent the development of chronic vascular insufficiency, you need to constantly pay attention to the condition of the blood vessels, try to eat less foods containing large amounts of cholesterol, and regularly examine the heart and circulatory system. Hypotonic patients are prescribed blood pressure medications as a preventative measure.

Acute vascular insufficiency - a pathological condition characterized by disorders of general or local circulation, the basis of which is the insufficiency of the hemodynamic function of blood vessels due to disturbances in their tone, patency, and a decrease in the volume of blood circulating in them.

Diagnosis OSN. established on the basis of a set of symptoms of systemic hemodynamic insufficiency, which can form a clinical picture of syncope, collapse or shock.

Fainting not in all cases accompanied by a complete loss of consciousness (syncope), sometimes limited to its predecessors: a sudden feeling of lightheadedness, ringing or noise in the ears, unsystematic dizziness, the appearance of paresthesia and severe muscle weakness and only clouding of consciousness (lipotymia), and therefore the patient does not falls and gradually settles.

Clinic: rapidly increasing pallor of the face, cold sweat, coldness and pallor of the hands and feet, a significant weakening of pulse filling and bradycardia, except in cases where lipothymia is caused by a paroxysm of tachycardia (in this case, the pulse rate usually exceeds 200 per 1 min).

In case of loss of consciousness: pallor and coldness of all skin and mucous membranes, loss of muscle tone, areflexia, a significant decrease in the frequency and depth of breathing, which sometimes becomes invisible (but is determined by the fogging of a mirror brought to the patient’s mouth or nose), sometimes the appearance of tonic convulsions (convulsive fainting). In this case, blood pressure and pulse in the peripheral arteries are often not determined, but rare and small pulse waves can usually be detected in the carotid arteries. in the initial stages of vagovasal syncope, the pupils are often constricted; with deep syncope of any etiology, the pupils become wide, and there are no pupillary reactions. When the body is in a horizontal position, the symptoms of fainting regress, usually within 1-3 min.

The occurrence of fainting in a stuffy room or as a reaction to pain, the sight of blood (especially in adolescents and young women), constriction of the pupils, rapid (in less than 1 min) restoration of consciousness, blood pressure and correct heart rhythm, the absence of pathological tones and noises during auscultation of the heart after restoration of consciousness are characteristic of simple fainting. If a deep faint occurs with a rapid (almost without warning) loss of consciousness due to turning the head, fastening the button of a tight collar or in response to palpation of the neck (especially in elderly people), when a sharp constriction of the pupils is detected and a relatively long period of time (up to 20-30 With) asystole - hypersensitivity of the carotid sinus.

Orthostatic - with a sharp transition from a horizontal to a vertical position, or during prolonged immobile standing, the period of lipothymia is limited (if the patient manages to take a horizontal or semi-horizontal position), and in the event of syncope developing, consciousness with a horizontal position of the body is restored as quickly as with simple fainting.

Cardiogenic syncope is characterized by less respiratory depression than other syncope (it may even be increased), a possible combination of pale skin with cyanosis (especially of the lips) and the presence of auscultatory signs of cardiac arrhythmias or mitral stenosis or aortic heart disease.

Collapse as an independent form of clinical manifestations of acute S. n. characterized by symptoms of progressive insufficiency of blood supply to all organs and tissues (primarily peripheral), most often in combination with signs of compensatory reactions of centralization of blood circulation. The patient suddenly develops increasing general weakness, initially accompanied by a feeling of fear (anxiety, melancholy), excitement, which is replaced by physical inactivity and apathy; cold sweat appears, hands and feet become cold; facial features become sharper, the skin becomes pale gray in color; lips, sometimes also hands (with cardiogenic collapse) are cyanotic; breathing quickens and becomes shallow. Heart sounds often remain normal or even become louder, but with toxic and cardiogenic collapse they are often muffled and arrhythmic; in the vast majority of cases, tachycardia is observed, in all cases - a small (thread-like) pulse and a decrease in systolic blood pressure. Diastolic and, accordingly, pulse blood pressure changes differently, depending on the origin of the collapse. As blood pressure decreases, oliguria and anuria develop. Consciousness is preserved in most cases (it may be absent due to an underlying disease, such as a traumatic brain injury), but when trying to sit the patient down, fainting often occurs.

collapse develops against the background of an underlying disease, poisoning or injury. most often there is internal bleeding (for example, due to ectopic pregnancy, perforated gastric ulcer), and in middle-aged and elderly people - acute myocardial infarction and pulmonary embolism.

Hemorrhagic collapse is characterized by pronounced pallor and coldness of the skin (virtually without cyanosis), a predominant decrease in pulse blood pressure at first, increasing significant tachycardia, sometimes euphoria, mental disorders, orthostatic fainting. In acute myocardial infarction, collapse is often preceded or accompanied by an anginal status, characterized by a significant suppression of cardiac gonorrhea, the appearance of various cardiac arrhythmias, sometimes a gallop rhythm and other signs of acute left ventricular heart failure. Thromboembolism of the pulmonary arteries should be assumed in all cases when collapse is accompanied by severe tachypnea and tachycardia, a sharp increase and emphasis of the second heart sound over the pulmonary trunk.

Shock in its manifestations are wider than the manifestations of S. science itself. its clinical picture is different and depends on the etiology of shock (Anaphylactic shock, Traumatic shock, etc.) and the stage of its development. As a particularly severe clinical form of acute S. n. shock is characterized by a picture of collapse combined with signs of severe microcirculation disorders in the body. In this regard, the diagnosis of shock is justified by adding to the manifestations of deep collapse anuria, hypothermia of the body (a sign of blockade of cellular metabolism) and the symptom of “marble skin” - the appearance on the pale gray cold skin of the extremities and torso of white, cyanotic and red-cyanotic spots and stripes due to with severe microcirculation disorders.

Treatment. First aid for fainting. The patient should be placed on his back with his legs elevated, loosen tight clothing, provide an influx of fresh air, and inhale ammonia (irritation of the nasal mucosa with a reflex effect on the vasomotor center of the brain); subcutaneous injections of cordiamine (2 ml), caffeine (1 ml of 10% solution) are indicated. Patients with suspected organic diseases and with an unclear genesis of fainting should be hospitalized.

intravenously or subcutaneously 2 ml 10% sodium caffeine benzoate solution, and if severe bradycardia persists, also 0.5-1 ml 0.1% atropine solution. The latter quickly eliminates bradycardia in carotid sinus hypersensitivity syndrome, but is not always effective enough in cardiogenic syncope, and if bradycardia and low blood pressure persist, a 0.1% solution of adrenaline should be slowly administered intravenously at 20 ml isotonic sodium chloride or glucose solution.. If after 2-3 min from the moment syncope occurs, the patient remains unconscious, there are no reflexes, blood pressure, pulse and heart sounds cannot be determined (a picture of clinical death), these drugs are administered intracardially and chest compressions and artificial respiration are started. For recurrent orthostatic and vagovasal syncope, the patient is advised to undergo planned hospitalization. In most cases, simple fainting does not require hospitalization.

Patients with collapse or shock of any etiology are urgently hospitalized in departments. At the prehospital stage, if possible, the cause of collapse is eliminated (for example, by stopping external bleeding by applying a bandage or tourniquet), pathogenetic therapy is carried out and symptomatic means are used to restore and maintain blood pressure, cardiac activity and other vital autonomic functions.

In case of cardiogenic collapse, etiotropic therapy is leading: relief of paroxysm of tachycardia, atrial flutter, use of atropine and alupentine (isadrin) or adrenaline in the event of sinoauricular or atrioventricular heart block, administration of heparin or thrombolytic agents in acute myocardial infarction and in pulmonary embolism, if collapse has developed against the background of anginal status, neuroleptanalgesia is performed. To restore blood pressure and maintain it during transportation of the patient at the prehospital stage, it is advisable to use a 1% mesatone solution (0.5-1 ml subcutaneously), other α-adrenergic agonists (norepinephrine, adrenaline) act for a short time, so they (like dopamine) are administered intravenously in the hospital.

In case of hypovolemic collapse against the background of severe dehydration of the body (including burn shock), as well as in case of hemorrhagic collapse (shock), saving the patient’s life depends on the earliest possible start of infusion of plasma substitutes or blood. Therefore, after emergency measures to ensure the possibility of transporting the patient (stopping bleeding, resuscitation procedures), the main attention is paid to the rapid delivery of the patient to the hospital.